Letter From the Editor

Correctional Physicians in a Quandary About Hepatitis C Treatment

As the main article shows, even experts cannot agree on specific criteria for hepatitis C treatment eligibility. Consensus is emerging that abnormal liver function tests do not preclude progression of cirrhosis in certain patients. Consequently, some say that only biopsy changes, not liver function tests, can be used as a guide to treatment eligibility. More and more evidence is appearing in the literature supporting the performance of liver biopsies in nearly all cases of HCV infection. In corrections, these tests are expensive and logistically complicated. The correctional physician is caught in a vise-like dilemma between the clamor for more HCV diagnosis and treatment and the lack of established criteria predicting who would benefit from these expensive therapies.

Drug availability is also an issue. Currently, PEG-Intron (Schering-Plough) is not available immediately to all patients who are prescribed treatment. While a number of correctional systems are prescribing PEG-Intron to inmates, there seems to be a substantial difficulty in securing sufficient supplies of this drug for both correctional and non-correctional patients.

In response to the shortage, Schering devised the Access Assurance Program. The prescribing clinician must fill out forms and request the patient to be enrolled in the Access Assurance. After acceptance, the patient may have to wait variable periods, up to 11 weeks, to receive the first dose. Once started, however, Schering guarantees uninterrupted access to PEG-Intron for the duration of the treatment. At time of this writing, there were still shortages of PEG-Intron and a waiting list. In prison systems, where inmate transfers between institutions are frequent, the inability to keep stocks of PEG-Intron poses a serious logistical problem. Inmates may arrive to an institution without their PEG-Intron. It may take several days to secure the inmate's allocated PEG-Intron from Schering-Plough.

This is a good time to remind ourselves to keep informed about these rapid developments and to network with other correctional physicians in mutual support. Our patients deserve no less.

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This article will review the status of HCV management in correctional settings, provide new information on the interaction between HIV infection, HIV treatment, and HCV, and review guidelines on the management of HCV in HIV infected patients.

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